title: Birth-related mid-posterior rib fractures in neonates: a report of three cases (and a possible fourth case) and a review of the literature.
abstract: BACKGROUND
  Posterior rib fractures in young children have a high positive predictive value for non-accidental injury (NAI). Combined data of five studies on birth trauma (115,756 live births) showed no cases of rib fractures resulting from birth trauma. There have, however, been sporadic cases reported in the literature.
  
  
  OBJECTIVE
  We present three neonates with both posterior rib fractures and ipsilateral clavicular fractures resulting from birth trauma. A review of the literature is also presented. The common denominator and a possible mechanical aetiology are discussed.
  
  
  METHODS
  In total, 13 cases of definitive birth-related posterior rib fractures were identified.
  
  
  RESULTS
  Nearly all (9/10) posterior rib fractures were (as far as reported in the original publications) in the midline. In 12 of the 13 children, birth weight was high and in 7 children birth was complicated by shoulder dystocia. An interesting finding was that in cases where a clavicular fracture was present, this was on the ipsilateral side.
  
  
  CONCLUSIONS
  Radiologists, when presented with a neonate with posterior rib fractures, should be aware of this rare differential diagnosis.
authors.affiliation: Department of Radiology, Academic Medical Centre Amsterdam, Meibergdreef 9, Amsterdam Zuid-Oost 1105 AZ, The Netherlands. r.r.vanrijn@amc.uva.nl
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
authors.forename: Rob A C
authors.initials: RA
authors.lastname: Bilo
authors.forename: Simon G F
authors.initials: SG
authors.lastname: Robben
mesh_terms: D001720:Birth Injuries / Q000000981:diagnostic imaging*; D002968:Clavicle / Q000293:injuries*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012253:Rib Fractures / Q000000981:diagnostic imaging*